Defense Base Act: What about disputed claims?

disputed workman compensation claim     Sometimes the claims for workers’ compensation under the Defense Base Act (an extension of the Longshore & Harbor Workers Compensation Act) are disputed by the employer or the insurance company.  There are a number of reasons these claims might be disputed.  The employer might be questioning whether the injury occurred in the course and scope of your job, or claiming that the injury was a result of your own actions, such as being intoxicated and hurt in a bar fight, or for several other reasons we will discuss later in this article.

     If your employer (really, its insurance company) does not pay your benefits in a timely manner, or if you have been sent a notice of dispute, you need to contact an attorney immediately to protect your rights under the DBA.  There are specific time limits for protecting your rights under a disputed claim.  If these time limits are “blown” then it will make getting what you are entitled to much more difficult.  You don’t want the insurance company to claim you were “sitting on your rights” and therefore not really interested in claiming them.

      First, claims must be filed with a central clearinghouse office of the Division of Longshore & Harbor Workers Compensation, which is then forwarded to the appropriate district office of the United States Department of Labor.  Each district office oversees claims from different parts of the world – for example, claims arising out of work in the Western Hemisphere of the world, such as Iraq, Afghanistan or Europe would be adjudicated out of the Region II New York office. Experienced Defense Base Act attorneys know the particulars of where and when to file claims, how to proceed for disputed claims and how to prove your medical circumstances if they are called into question by the insurance company.

     Another important factor in working any claim – disputed or not – is to make sure that your Average Weekly Wage (AWW) has been accurately calculated.  Since the amount of your disability compensation is based on your Average Weekly Wage, often employers or insurance companies will not include all your earnings so they can minimize your AWW.  An experienced Defense Base Act attorney will ensure that the other side is calculating your benefits correctly.

     Getting a proper medical evaluation is also a critical factor in successfully prosecuting a Defense Base Act  claim, especially if the claim has been disputed.  Many of the awards for permanent partial disabilities are based on a percentage of impairment of the body part.  It is vitally important that your injury is assessed by a doctor who is competent and experienced in assigning disability ratings.  Be assured that the doctor hired by the insurance company is looking to minimize the percentage of disability and also the dollar amount due to you.

How does the disputed claim get resolved?

     You have been injured working for a U.S. contractor overseas.  You get immediate medical attention, notify your employer and file the necessary claim with the Department of Labor, the LS-203 Employee’s Claim for Compensation.  The employer must file a LS-201, Notice of Employee’s Injury or Death.  There is additional paperwork that must be filed, and here is where it is a great idea to have an experienced Defense Base Act attorney.  Among other forms, you must file a report on your earnings – and you must be careful to make sure you are reporting everything properly to ensure getting your maximum benefit.

      If the employer files an LS-207, Notice of Controversion of Right to Compensation, then they or the insurance company is disputing the claim.  There are several reasons the claim might be disputed.  It may be the employer thinks the injury did not occur at work, ort that there was no Defense Base Act coverage at time of injury.  It may be they think there is no medical evidence to support the disability, or that they need more time to investigate the claim & get additional facts, or it may be there is a conflict of medical evidence.  Whatever their reason (and it has to be stated on the LS-207), you definitely need professional help in pursuing your claim.  Don’t hesitate to get an experienced DBA attorney, and definitely don’t agree to anything or sign anything until you have this help.

     An informal conference at the district office is scheduled based upon the disputed issues. The parties (including claimant, employer/carrier, and attorneys) may appear in person or by telephone.  All sides present their positions and supporting evidence (i.e. medical reports or earnings information). The district office reviews the evidence and issues a recommendation which parties can accept or further dispute.

     District office recommendations are not binding on the parties. If the parties do not accept the informal conference recommendations, they may request a hearing before the Office of Administrative Law Judges. These formal hearings can be scheduled anywhere. The ALJ issues a binding decision & order, which may be appealed to the Benefits Review Board if the parties do not agree.

     The District Director may issue binding compensation orders by agreement of the parties, when there are disputed issues such as continuing disability, degree of disability, facts of the case, medical treatment and/or medical bills. Both parties benefit from this binding order – the claimant receives a lump sum and the employer/carrier is discharged from further liability.

     This dispute resolution process can be time consuming and frustrating, especially if you are in need of the financial compensation (and who isn’t in need of money?)   Experienced Defense Base Act  attorneys can help you through this time by taking care of the legal necessities, while you focus on recovering.  They know the process, know the proper procedures, and can help resolve your disputed claim to your best advantage. Especially in cases where a claim is being disputed, don’t try to go it alone –get legal help with experience in Defense Base Act claims.